The ICT ecosystem is a new and emerging concept which suggests that ICTs should not be viewed as technical systems in insolation, but rather as a part of a wider network that takes into account non-technical dynamics, being socio-economic, political, spatial, and such. Nguyen, Nielsen, and Sæbø (2017) have conceptualized the national ICT ecosystem which adequately describes the socio-technical components surrounding an ICT embedded within a country. However, their conceptualization is merely a static description of the ecosystems’ components without sufficient description of their dynamics. Based on a case study of a health management information system and its surrounding ecosystem in Tanzania, we contribute by identifying three dynamics of national ICT ecosystems: (1) evolution occurring in small and incremental steps; (2) co-adaption in the ecosystem following integrations between ICTs; and (3) ICTs being integrated due to perceived network effects